So, having bought or rescued a new female cat, you will find yourself with an array of bewildering decisions to make. You have: 

  1. Tackled the minefield that is settling on a name that reflects the personality of your miniature tiger.
  2. Chosen that flash diet that has subliminally been making an impression during commercial breaks of your favourite soap.
  3. Bought some designer cat furniture costing more than the average family sized 3-piece suite.

Now the day has come to take your bundle of fluff, teeth and sharp claws to see the local vet. Jabs for ‘X, Y & Z’, spot-on for this, tablets for that, and the inevitable questions regarding your pet’s family planning. The promiscuity of cats being what it is, the decision for most will be to have their cat spayed to avoid being inundated with hundreds of kittens.

What is a spay?

For a spay surgery, a cat will receive a general anaesthetic so they are fully asleep for the entirety of the procedure. The skin at the surgery site will be shaved to ensure a fur-free sterile site and either an ovariectomy (removal of the ovaries) or ovariohysterectomy (removal of the ovaries and uterus) will be performed. This procedure permanently prevents a cat from being able to have kittens.

Either after some online research on the topic or after a discussion with friends and family, you find yourself asking whether there is potentially one more decision to make. This is because there are two recognised techniques for spaying cats:

  • Midline approach – an incision is made on the underside of the cat in the middle of their tummy
  • Flank approach – an incision is made on the side of the cat on the left side of the body wall

Both result in the same outcome, so should you care which technique is used? 

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Which is better?

  • Pain – A variety of veterinary studies have assessed whether midline or flank cat spays are less painful following surgery. Individual studies may have suggested that one technique is preferable to another. However, up-to-date research indicates no clear evidence of one approach being more or less painful than the other. With appropriate post-op pain relief, we would expect your cat to be comfortable following surgery with either technique. 
  • Complications – Similarly, multiple studies have assessed whether either technique is associated with a higher rate of post-operative wound complications. Importantly, current evidence indicates neither approach is consistently associated with more wound complications. Overall complication rates for the surgery are also low. 
  • Surgery time – Some studies suggest a flank approach might result in a slightly shorter surgery time, but the difference is minimal (approximately one and a half minutes difference only).
  • Surgeon experience – Most vets have an individual preference of one technique over the other based on their experience. There are individual circumstances when a midline or flank approach may be more appropriate. Otherwise, your vet will typically perform the approach based on their own personal experience/preference. 

When may a midline approach be more appropriate?

  • Pregnancy – If your cat is pregnant or suspected to be pregnant at the time of their spay surgery, a midline incision is usually performed. This is to allow a larger incision and increased access to the abdomen. 
  • Pyometra – An infection of the uterus which can be life threatening. This is most commonly seen in middle aged to older cats, but can be seen at any age. Typically, this is treated by removal of the uterus and ovaries (spay surgery) to remove the source of the infection, along with supportive care (antibiotics, pain relief, fluids etc). A larger incision is needed for this surgery and greater access to structures within the abdomen. Therefore, spaying cats for pyometra is typically performed via a midline incision. 
  • Temperature sensitive coat Skin temperature is important in determining the coat colour in some breeds of cat (e.g. Siamese and Ragdolls), giving them darker ‘points’ (tail, paws, face and ears). When a patch of fur is shaved for surgery, the underlying skin will be cooler, which can result in the fur growing back a darker colour. For this reason, some people prefer to have these particular breeds of cat spayed midline. This way, any colour change will be less visible. 

When may a flank spay be more appropriate?

  • Feral cats/fractious cats – Some clinicians prefer a flank spay for feral cats or those which are difficult to handle at the vets as it is easier to check this area post-operatively for complications in patients which are difficult to handle. 

Conclusion

There is no evidence that either technique is less painful, significantly faster or has fewer complications. So, this is one decision you don’t need to make and rather leave your vet to make the decision based on their surgical preference and your cat’s individual circumstances. It’s time instead to focus on the next big decision, like who is going to be trusted with looking after your bundle of joy when you are away… Or solving the mystery of why ‘Mittens’ is more interested in sleeping on that £5 pillow, instead of the giant architect’s folly you purchased as a cat tower!